<form id='form_corp_step1' method='post' action='<?php echo site_url("create_account/save/11")?>' onsubmit="return Send('#form_corp_step1');">
	
	<table cellspacing='0' cellpadding='0' width="100%" class="reviewTables">
		<tr>
			<td colspan='4'>
				<div class='lbackground'></div>
					<div class='header_center'>
						Company Information:
					<div class='rbackground'></div>
				</div>
			</td>
		</tr>
	
		<tr><td width='205'>
				<label id='companyNameLbl' for='companyName'>Company Name:*</label>
			</td>
			<td>
				<input id='companyName' name='companyName' type='text' size='25' ></input>
			
		</td></tr>
		
		<tr><td>
				<label id='regNumberLbl' for='regNumber'>Company Registered Number:*</label>
			</td>
			<td>
				<input id='regNumber' name='regNumber' type='text' size='25' ></input>
			
		</td></tr>
		
		<tr><td>
				<label id='countryCorpLbl' for='countryCorp'>Country of Incorporation:*</label>
			</td>
			<td><select id='countryCorp' name='countryCorp'>
					<option value=''>Select One</option>
					<option value=''>------------</option>
					<?php foreach($countries as $item){?>
					<option value='<?php print $item->ID; ?>'
						rel='<?php print $item->AREA_CODE; ?>'>
						<?php print $item->NAME; ?>
					</option>

					<?php }?>
			</select>
		</td></tr>
		
		<tr><td width='150'>
			<label id='incorpDayLbl' for='incorpDay'>Date of Incorporation:*</label>
	      </td><td>
		    <select id='incorpDay' name='incorpDay'>
			  <option value=''>DD</option>
			  <?php for($day = 1; $day <= 31; $day++){?>
			  <option value='<?php print $day; ?>'><?php print $day; ?></option>
			  <?php }?>
		    </select>
		    /
		    <select id='incorpMonth' name='incorpMonth'>
			  <option value=''>MM</option>
			  <?php for($mon = 1; $mon <= 12; $mon++){?>
			  <option value='<?php print $mon; ?>'><?php print $mon; ?></option>
			  <?php }?>
		    </select>
		    /
		    <select id='incorpYear' name='incorpYear'>
			  <option value=''>YYYY</option>
			  <?php for($y = 1980; $y <= 2010; $y++){?>
			  <option value='<?php print $y; ?>'><?php print $y; ?></option>
			  <?php }?>
		    </select>
      	</td></tr>
	</table>
	
	<div id='space'></div>
	
	<table cellspacing='0' cellpadding='0' style='display:table;'  width="100%" class="reviewTables">
		<tr>
			<td colspan='4'>
				<div class='lbackground'></div>
					<div class='header_center'>
						Registered Address:
						<div class='rbackground'></div>
					</div>
			</td>
		</tr>
		<tr>
			<td  width='150'>
				<label id='countryRegLbl' for='countryReg'>Country:*</label>
			</td>
			<td colspan="3">
				<select id='countryReg' name='countryReg'>
					<option value=''>Select One</option>
					<option value=''>------------</option>
					<?php foreach($countries as $item){?>
					<option value='<?php print $item->ID; ?>'
						rel='<?php print $item->AREA_CODE; ?>'>
						<?php print $item->NAME; ?>
					</option>

					<?php }?>
				</select>
			</td>
		</tr>
		<tr>
			<td>
				<label for='addressLine1Main' id='addressLine1MainLbl'>Address line 1:*</label>
			</td>
			<td colspan='3'>
				<input name='addressLine1Main' type='text' size='45' class="longInput"></input>
			</td>
		</tr>

		<tr>
			<td>
				<label for='addressLine2Main' id='addressLine2MainLbl'>Address line 2:</label>
			</td>
			<td colspan='3'>
				<input name='addressLine2Main' type='text' size='45' class="longInput"></input>
			</td>
		</tr>

		<tr>
			<td>
				<label for='cityMain' id='cityMainLbl'>City/Town:*</label>
			</td>
			<td>
				<input name='cityMain' type='text' size='20'></input>
			</td>
			<td>
				<label for='regionMain' id='regionMainLbl'>County/State:</label>
			</td>
			<td>
				<input name='regionMain' type='text' size='20'></input>
			</td>
		</tr>

		<tr>
			<td>
				<label for='pCodeMain' id='pCodeMainLbl'>Postal Code:</label>
			</td>
			<td colspan="3">
				<input name='pCodeMain' type='text' size='20'></input>
			</td>
		</tr>

		
		<tr>
			<td colspan='4'>
				<label for='phone1' id='phone1Lbl'>Phone:* </label> 
				<input id='phone1' name='phone1' type='text' size='6' maxlength='6'></input>- 
				<input id='phone2' name='phone2' type='text' size='6' maxlength='6'></input>- 
				<input id='phone3' name='phone3' type='text' size='10' maxlength='10' style='margin-right:25px;'></input>
				
				<label for='mobilePhone1' id='mobilePhone1Lbl'>Mobile: </label> 
				<input id='mobilePhone1' name='mobilePhone1' type='text' size='6' maxlength='6'></input>-
				<input id='mobilePhone2' name='mobilePhone2' type='text' size='6' maxlength='6'></input>- 
				<input id='mobilePhone3' name='mobilePhone3' type='text' size='10' maxlength='10'></input>

				<br /> 
				<span id='phoneHint' class='msg_important'>
					(country code + area code + number) 
				</span>
				<span  id='phoneHint' class='msg_important' style='padding-left:200px;'>
					(country code + area code + number)
				</span>
			</td>
		</tr>
	</table>

	<div id='separate_mailing_container'>
		<input name='separateMailing' id='separateMailing' type='checkbox' value='1'></input> 
		<label for='separateMailing' id='separateMailingLbl'>I would like to provide a separate mailing address.</label>
	</div>
	
	
	
	<div id='mailingAddress'>
		<div id='space'></div>
		
		<table cellspacing='0' cellpadding='0' width="100%" class="reviewTables">
			<tr>
				<td colspan="4">
					<label>Enter mailing address:</label>
				</td>
			</tr>
			<tr>
				<td width='150'>
					<label id='countryMailingLbl' for='countryMailing'>Country:*</label>
				</td>
				<td colspan="3">
					<?php //echo form_dropdown('countryMailing', $options, 'large', $js);?>
					<?php //print_r($countries);?>
					
					<select id='countryMailing' name='countryMailing'>
						<option value=''>Select One</option>
						<option value=''>------------</option>
						<?php foreach($countries as $item){?>
						<option value='<?php print $item->ID; ?>' rel='<?php print $item->AREA_CODE; ?>'>
							<?php print $item->NAME; ?>
						</option>

						<?php }?>
					</select>
				</td>
			</tr>
			<tr>
				<td>
					<label for='addressLine1Mailing' id='addressLine1MailingLbl'>Address line 1:*</label>
				</td>
				<td colspan='3'>
					<input name='addressLine1Mailing' type='text' size='45' class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td>
					<label for='addressLine2Mailing' id='addressLine2MailingLbl'>Address line 2:</label>
				</td>
				<td colspan='3'>
					<input name='addressLine2Mailing' type='text' size='45' class="longInput"></input>
				</td>
			</tr>

			<tr>
				<td>
					<label for='cityMailing' id='cityMailingLbl'>City/Town:*</label>
				</td>
				<td>
					<input name='cityMailing' type='text' size='20'></input>
				</td>
				<td>
					<label for='regionMailing' id='regionMailingLbl'>County/State:</label>
				</td>
				<td>
					<input name='regionMailing' type='text' size='20'></input>
				</td>
			</tr>

			<tr>
				<td>
					<label for='pCodeMailing' id='pCodeMailingLbl'>Postal Code:</label>
				</td>
				<td colspan="3">
					<input name='pCodeMailing' type='text' size='20'></input>
				</td>
			</tr>

		</table>
	</div>
	
	<div id='space'></div>
	
	<table cellspacing='0' cellpadding='0' width="100%" class="reviewTables">
	    <tr><td colspan='4'>
	    	<div class='lbackground'></div>
				<div class='header_center'>
				    Officers of the Company: Principal contact:
				<div class='rbackground'></div>
				</div>
	    </td></tr>
	    <tr><td>
		    <label id='titleLbl' for='title'>Title:*</label>
		    <select id='title' name='title'>
		      <?php $selected = "selected='selected'";?>
			  <option value='Mr.' <?php if($_title == "Mr.") echo $selected;?> >Mr.</option>
			  <option value='Mrs.' <?php if($_title == "Mrs.") echo $selected;?> >Mrs.</option>
			  <option value='Ms.' <?php if($_title == "Ms.") echo $selected;?> >Ms.</option>
		    </select>
		    <label for='firstName' id='firstNameLbl'>First:*</label>
		    <input name='firstName' type='text' size='20' value="<?php echo $firstName;?>"></input>
		    <label for='middleName' id='middleNameLbl'>Middle:</label>
		    <input name='middleName' type='text'  size='2' maxlength='2' value="<?php echo $middleName;?>"></input>
		    <label for='lastName' id='lastNameLbl'>Last:*</label>
		    <input name='lastName' type='text'  size='20' value="<?php echo $lastName;?>"></input>
	    </td></tr>
	    
	    <tr><td>
			<label for='position' id='positionLbl'>Position:*</label>
			<input name='position' id='position' type='text' size='25'></input>
		</td></tr>
	    
	    <tr id='email'><td colspan='4'>
			<label for='email' id='emailLbl'>E-mail:*</label> 
			<input name='email' type='text' value="<?php echo $email;?>"></input>
	        <label id='verififyEmailLbl' for='verififyEmail'>Verify E-mail:*</label>
			<input name='verifyEmail' type='text' value="<?php echo $email;?>"></input>
	    </td></tr>
	    
    </table>
    
    <div class='msg'>
		Important: Email is our primary method of contacting you, both to complete the application process and for ongoing client communication.
    </div>
    <div id='space'></div>
	    
    
    
    <table cellpadding="0" cellspacing="0" width="100%" class="reviewTables">
    	<tr><td colspan='4'>
    		<div class='lbackground'></div>
				<div class='header_center'>
				Other Officers:
				<div class='rbackground'></div>
			</div>
		</td></tr>
	
    	<tr><td>
			<label for='offName1' id='offName1Lbl'>Name:*</label>
		</td><td>
			<input name='offName1' id='offName1' type='text' size='25'></input>
		</td><td>
			<label for='offPosition1' id='offPosition1Lbl'>Position:*</label>
		</td><td>
			<input name='offPosition1' id='offPosition1' type='text' size='25'></input>
		</td></tr>
		
		<tr><td>
			<label for='offName2' id='offName2Lbl'>Name:</label>
		</td><td>
			<input name='offName2' id='offName2' type='text' size='25'></input>
		</td><td>
			<label for='offPosition2' id='offPosition2Lbl'>Position:</label>
		</td><td>
			<input name='offPosition2' id='offPosition2' type='text' size='25'></input>
		</td></tr>
		
		<tr><td>
			<label for='offName3' id='offName3Lbl'>Name:</label>
		</td><td>
			<input name='offName3' id='offName3' type='text' size='25'></input>
		</td><td>
			<label for='offPosition3' id='offPosition3Lbl'>Position:</label>
		</td><td>
			<input name='offPosition3' id='offPosition3' type='text' size='25'></input>
		</td></tr>
    </table>

	<div id="space"></div>
	
	<div id='submit_section' style='text-align: center;'>
		<input type='submit' value='Save & Continue' title='Save the form and continue to the next step' />
	</div>
</form>
